Apparatus for ligating living tissues

ABSTRACT

The present invention has an introducing tube capable of being inserted into a living body cavity, a manipulating wire movably inserted into this introducing tube, at least two or more clips, and a ligating wire causing the clip and the manipulating wire to be engaged with each other wherein, when the clip is ligated, a tensile stress of the manipulating wire is always applied only to the clip located at the most distal end.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is based upon and claims the benefit of priority fromthe prior Japanese Patent Applications No. 2001-063931, filed Mar. 7,2001; and No. 2001-321002, filed Oct. 18, 2001, the entire contents ofboth of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an apparatus for ligating livingtissues for clipping a living tissue by inserting a clip into a livingbody cavity in a transendoscopic manner.

2. Description of the Relate Art

Conventionally, in Jpn. Pat. Appln. KOKAI Publication No. 63-267345, forexample, it has been well known that a physiological tissue clippingapparatus incorporates a plurality of clips in an introducing tube, andcarries out legation work continuously. There has been proposed aclipping apparatus in which a plurality of clips is incorporated in anintroducing tube, each of these clips and a manipulating member areconnected to each other with an aid of a substance having its lowmelting point, and the substance having its low melting point is fusedwhile the clips are inserted in the cavity so as to continuously carryout a clip legation work.

However, this clipping apparatus disclosed in Jpn. Pat. Appln. KOKAIPublication No. 63-267345 requires heating means for generating a heatduring clip opening and during clip legation. Thus, there has been aproblem that clip legation requires a complicated work and much time. Inaddition, in carrying out legation while a clip is protruded from anintroducing tube, when the clip is protruded, one must manipulate theapparatus while observing an endoscopic image. In addition, carefulprotrusion work is required at the front side of the clipping apparatus,and a plurality of clips may be protruded from a distal end of theintroducing tube at one breath.

BRIEF SUMMARY OF THE INVENTION

The present invention has been made in order to solve the foregoingproblem. It is an object of the present invention to provide anapparatus for ligating living tissues capable of speedily and easilycontinuing a clip legation work merely by extruding or retracting amanipulating wire while a plurality of clips are mounted in theintroducing tube and are inserted into the cavity.

It is another object of the present invention to provide an apparatusfor ligating living tissues capable of providing a mechanism forpreventing any object other than clips mounted at the most distal endfrom being protruded from an introducing tube, thereby eliminating acareful work at its frontal side; enabling simplification ofmanipulation, enabling reduction of a surgical operation time whencarrying out continuous legation, and enabling reduction of burdens of apatient and a surgeon.

According to the present invention, there can be provided an apparatusfor ligating living tissues comprising:

an introducing tube capable of being inserted into a living tissue;

a manipulating wire movably inserted into the introducing tube;

at least two or more clips housed in the introducing tube; and

a connection structure for engaging the clips and the manipulating wirewith each other, wherein, in ligating the clips, a tensile stress of themanipulating wire is always applied only to the clip located at the mostdistal end.

Therefore, in ligating clips, the tensile stress of the manipulatingwire is always applied to the clip at the distal end, whereby, while aplurality of clips are mounted in the introducing tube, and are insertedinto the body cavity, a clip legation work can be continuously carriedout speedily and easily merely by extruding/retracting the manipulatingwire.

In addition, according to the present invention, there can be providedan apparatus for ligating living tissues comprising:

an introducing tube capable of being inserted into a living body cavity;

a manipulating wire movably inserted into the introducing tube; and

at least two or more clips each having a proximal end portion and havingan opening/expanding property in which a pinch portion is formed at adistal end of an arm section that extends from this proximal endportion, wherein two or more clips are disposed in series in theintroducing tube, and, in protruding the clips from the introducingtube, a mechanism for preventing any object other than the clip mountedat the most distal end from being protruded from the introducing tube.

Therefore, any object other than the clip mounted at the most distal endcan be prevented from being protruded from the introducing tube, and acareful work at its frontal side is eliminated.

Additional objects and advantages of the invention will be set forth inthe description which follows, and in part will be obvious from thedescription, or may be learned by practice of the invention. The objectsand advantages of the invention may be realized and obtained by means ofthe instrumentalities and combinations particularly pointed outhereinafter.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiment of the invention, andtogether with the general description given above and the detaileddescription of the embodiment given below, serve to explain theprinciples of the invention.

FIG. 1 is a longitudinal side section showing a distal end portion of aclipping apparatus according to a first embodiment of the presentinvention;

FIG. 2 is a longitudinal side section showing a distal end portion ofthe clipping apparatus according to the present embodiment;

FIG. 3 is a longitudinal side section showing a distal end portion ofthe clipping apparatus according to the present embodiment;

FIG. 4A is a plan view showing a clip according to the presentembodiment;

FIG. 4B is a plan view showing a clip according to the presentembodiment;

FIG. 4C is a view when the clip of the present embodiment is seen in adirection indicated by the arrow A in FIG. 4B;

FIG. 5 is a side view showing a state in which a target tissue isclipped by a clip according to the present embodiment;

FIG. 6 is a longitudinal side section showing a distal end portion of aclipping apparatus according to a second embodiment of the presentinvention;

FIG. 7A is a longitudinal side section showing a distal end portion of aclipping apparatus according to a third embodiment of the presentinvention;

FIG. 7B is a longitudinal side section seen in a direction indicated bythe arrow B in FIG. 7A;

FIG. 7C is a side view showing a modified example of a ligating wire;

FIG. 7D is a side view showing a modified example of a compressionmember;

FIG. 8 is a longitudinal side section showing a distal end portion of aclipping apparatus according to a fourth embodiment of the presentinvention;

FIG. 9 is a perspective view showing a partition member according to thepresent embodiment;

FIG. 10 is a sectional view taken along the line C-C in FIG. 8 accordingto the present embodiment;

FIG. 11 is a longitudinal side section showing a distal end portion of aclipping apparatus according to a fifth embodiment of the presentinvention;

FIG. 12 is a side view showing a restricting member according to thepresent embodiment;

FIG. 13A is a longitudinal side section showing a distal end portion ofa clipping apparatus according to a sixth embodiment of the presentinvention;

FIG. 13B is a view seen in a direction indicated by the arrow D in FIG.13A;

FIG. 13C is a view seen in a direction indicated by the arrow E in FIG.13A;

FIG. 14 is a side view showing a state in which a target tissue isclipped by a clip according to the present embodiment;

FIG. 15 is a perspective view showing a clip tightening ring accordingto the present embodiment;

FIG. 16A to FIG. 16D are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of aseventh embodiment according to the present invention;

FIG. 17A to FIG. 17E are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of aneighth embodiment according to the present invention;

FIG. 18A is a side view showing a manipulating section according to thepresent embodiment;

FIG. 18B is a sectional view taken along the line F-F in FIG. 18Aaccording to the present embodiment;

FIG. 19 is a longitudinal side section showing a clip tightening ringaccording to the present embodiment;

FIG. 20 is a longitudinal side section showing a modified example of theclip tightening ring according to the present embodiment;

FIG. 21A to FIG. 21D are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of aninth embodiment according to the present invention;

FIG. 22A to FIG. 22D are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of atenth embodiment according to the present invention;

FIG. 23A to FIG. 23E are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of aneleventh embodiment according to the present invention;

FIG. 24A to FIG. 24D are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of atwelfth embodiment according to the present invention;

FIG. 25A to FIG. 25D are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of athirteenth embodiment according to the present invention; and

FIG. 26A to FIG. 26D are longitudinal side sections each showing adistal end portion of a clipping apparatus for explaining working of afourteenth embodiment according to the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Hereinafter, preferred embodiments of the present invention will bedescribed with reference to the accompanying drawings.

FIG. 1 to FIG. 5 each show a first embodiment. FIG. 1 to FIG. 3 arelongitudinal side sections each showing a distal end portion in anapparatus for ligating living tissues. An introducing tube 1 hasflexibility such that the tube can be inserted into a channel of anendoscope. A distal end tip 2 is provided at a distal end portion ofthis introducing tube 1. This distal end tip 2 is fixed at the distalend portion of the introducing tube 1 by means of fusion welding,adhesive, or press-fit and the like. A manipulating wire 4 is movablyinserted into the introducing tube 1. At the distal end portion of thismanipulating wire 4, a clip 3 is fixedly mounted via a ligating wire 5.

The introducing tube 1 is provided as a coil sheath which has irregularinternal and external faces on which a metallic wire (such as astainless wire) whose section is round is closely wound. Thus, thisintroducing tube is structured so that the sheath does not break even ifa force of compressing the sheath is applied to the distal and proximalend portions of the sheath.

In addition, the introducing tube 1 may be a coil sheath such that itsflat internal and external faces are closely wound by a metallic wireafter the metallic wire (such as a stainless wire) having its sectionalround face has been crushed, and then, the sectional face of the wirehas been formed in a rectangular shape. In this case, the flat internalface makes it easy to protrude the clip 3 and insert the manipulatingwire 4. In addition, even if the element wire diameter of the same wireis used, a coil sheath with its large inner diameter can be provided ascompared with a round shaped coil sheath. This makes it much easier toprotrude the clip 3 and insert the manipulating wire 4.

Further, the introducing tube 1 may be a polymeric resin based tubesheath (such as synthetic polymeric polyamide, high density/low densitypolyethylene, polyester, polytetrafluoro ethylene, tetrafuoroethylene-perfluoroalkylvinyl ether copolymer, or tetrafluoroethylene-hexafluoro propylene copolymer). In this case, the internal andexternal faces of the sheath have slipping properties, thus making iteasy to insert/remove the tube into/from the endoscope channel, protrudethe clip 3, and insert the manipulating wire 4.

In addition, the introducing tube 1 may be a double tube having an innerlayer and an outer layer at a wall section and may be a tube sheathembedded while a reinforce member is interposed between the doubletubes.

In this case, the inner layer and outer layer are formed of thepolymeric resin. The reinforce member is formed of a cylindrical bladeor the like knitted with thin metal wires in a lattice shape. In thismanner, even when a force of compressing the sheath is applied to thedistal end portion and proximal end portion of the sheath, the sheathdoes not break because of its excellent compression resistance, ascompared with a tube sheath in which no reinforce member is embedded.

The dimensions of the introducing tube 1 are defined as an outerdiameter capable of being inserted into the endoscope channel. Thethickness of the sheath is determined depending on rigidity of theelement. When the introducing tube 1 is provided as a metallic sheath,the thickness is about 0.2 mm to 0.5 mm. In a tube made of a polymericresin, the thickness is about 0.3 mm to 0.6 mm. There is an advantagethat the reinforce member is embedded, thereby reducing the thicknessand increasing the inner diameter of the sheath.

The distal end tip 2 is provided as a metallic short tube (such as astainless tube), its outer periphery face is formed in a tapered shape,and its distal end portion is converged. This makes it easy to insertthe introducing tube 1 into the endoscope channel. In addition, itsinter periphery face is formed in a tapered shape as well, so that theclip 3 can be easily protruded from the distal end tip 2.

In addition, as shown in FIG. 4A to FIG. 4C, the inner diameter of thedistal end portion of the distal end tip 2 is dimensionally set so thatprojections 3 f and 3 f′ provided at arm sections 3 b and 3 b′ of theclip 3 described later are engaged therewith, and the arm sections 3 band 3 b′ of the clip 3 can be opened. The outer diameter of the mostdistal end of this distal end tip 3 is 1.5 mm to 3.3 mm in diameter, andthe inner diameter of the most distal end of the distal end tip 3 isabout 1.0 mm to 2.2 mm in diameter.

At the clip 3, a metallic thin band plate is bent at its center portion,and such a bent portion is provided as a proximal end portion 3 a. Thearm sections 3 b and 3 b′, both of which extend from this proximal endportion 3 a, are bent in an expanding/opening direction. Further, thedistal end rim portions of the arm sections 3 b and 3 b′ each are bendso as to face to each other, and the bent sections are defined as pinchsections 3 c and 3 c′. One of the distal ends of the pinch sections 3 cand 3 c′ is formed in a protrusive shape 3 d, and the other is formed ina recess shape 3 e so as to easily pinch a living tissue 6 (refer toFIG. 3). Then, opening/expanding properties are imparted to the armsections 3 b and 3 b′ so as to open the pinch sections 3 c and 3 c′.

Protrusions 3 f and 3 f′ capable of being engaged with the distal endtip 2 (when a clip proximal end 3 a is retracted into the distal end tip2) are provided at the arm sections 3 b and 3 b′ when the clip 3 isligated. As a material for a thin band plate of the clip 3, there isused a stainless having its resilience or an ultra-elastic alloy such asa stainless or nickel-titanium alloy.

The manipulating wire 4 is about 0.3 mm to 1.5 mm in outer diameter.This wire is provided as a twisted wire made of stainless. This twistedwire is more flexible than a single wire. Thus, the flexibility of theintroducing tube 1 itself is not degraded.

In addition, the manipulating wire 4 is connected to the clip 3 via theligating wire 5. The proximal end side of this ligating wire 5 is weldedor bonded with a distal end portion of the manipulating wire 4 byadhesive. In addition, the distal end side of the ligating wire 5 isbonded with the clip proximal end portion 3 a by welding, adhesive, oralternatively, by forming a loop, and then, routing it into a bentportion of the clip 3. Further, the ligating wire undergoesextruding/retracting movement together with the clip 3 in accordancewith extruding/retracting movement of the manipulating wire 4.

The ligating wire 5 is provided as a stainless based twisted wire or asingle wire, for example. The outer diameter of the ligating wire 5 is0.3 mm or less in diameter. Thus, it is required to define dimensionssuch that the ligating wire 5 breaks after a force of 1 to 5 Kg isapplied during clip legation.

Now, working of a first embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into abody cavity via the channel of the endoscope inserted into the cavity.Then, the distal end portion of the introducing tube 1 is located at thetarget tissue 6, for example, in close proximity to a gastric mucousmembrane tissue. The manipulating wire 4 is extruded in the distal enddirection of the introducing tube 1, thereby protruding the first clip 3located at the most distal end connected to the ligating wire 5 from thedistal end portion of a distal end tip 2.

At the clip 3, opening/expanding properties are imparted to the armsections 3 b and 3 b′ so as to open the pinch sections 3 c and 3 c′.Thus, the clip 3 is protruded from the distal end tip 2, and at the sametime, the pinch sections 3 c and 3 c′ open. While the pinch sections 3 cand 3 c′ are pushed against the target tissue 6, the manipulating wire 4is retracted. The clip arm sections 3 b and 3 b′ bend in theexpanding/opening direction are engaged with the distal end portion ofthe distal end tip 2.

When the manipulating wire 4 is further retracted, the projections 3 fand 3 f′ provided at the clip arm sections 3 b and 3 b′ are engaged withthe distal end tip 2, and the traction force is applied only to the clip3. Therefore, as shown in FIG. 5, the proximal end portion 3 a of theclip 3 is plastically deformed, and the pinch sections 3 c and 3 c′close, whereby the target tissue 6 can be pinched.

Further, the manipulating wire 4 is retracted, and the traction force isapplied to the ligating wire 5 bonded with the proximal end portion 3 aof the clip 3′. Then, the ligating wire 5 itself connected to the clip 3breaks, and the manipulating wire 4 and clip 3 are completely separatedfrom each other. In this manner, legation of the first clip 3 located atthe most distal end completes. The second or later clip 3 can be ligatedin the same manner as in the first clip.

According to the first embodiment, the respective clip and manipulatingwire are bonded with each other by means of the ligating wire, whereby aclip legation work can be continuously carried out speedily and easilymerely by extruding/retracting the manipulating wire. This makes itpossible to reduce a surgical operation time and to reduce burdens ofthe patient and surgeon.

FIG. 6 is a longitudinal side view showing a distal end portion of aclipping apparatus according to a second embodiment. Like constituentelements in the first embodiment are designated by like referencenumerals. A duplicate description is omitted here. A loop shape 7 a isformed at the proximal end side of the ligating wire 7 connecting themanipulating wire 4 and clip 3 with each other, and the loop 7 a isrouted into the manipulating wire 4. In addition, the distal end side ofthe ligating wire 7 is welded and bonded with the proximal end portion 3a of the clip 3, or alternatively, is bonded by forming the loop 7 a,and then, mounting the loop on the proximal end portion 3 a of the clip3. Further, the ligating wire can freely move on the operating wire 4without following the extruding/retracting movement of the manipulatingwire 4.

This ligating wire 7 is provided as a metallic twisted wire or a singlemetallic wire, and is made of a polymeric fiber such aspolyparaphenylenebenzo bis oxazol, polyethylene, or a liquid crystalpolymer.

In addition, the outer diameter of the ligating wire 7 is 0.3 mm or lessin diameter. In addition, it is required to set the outer diameter todimensions such that the ligating wire 7 breaks when a force of 1 to 5Kg is applied during legation of the clip 3.

Further, a stopper 8 is provided at the proximal end portion of theligating wire 7. This stopper 8 can be inserted into the introducingtube 1, and is bonded with the distal end portion of the manipulatingwire 4 by welding or adhesive. The stopper 8 is made of stainless orrubber and the like, for example, and has its size such that the loop 7a at the proximal end side of the ligating wire 7 does not slip off fromthe manipulating wire 4.

Now, working of a second embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.The distal end portion of the introducing tube 1 is located at thetarget tissue 6, for example, in close proximity to the gastric mucousmembrane tissue. The manipulating wire 4 is extruded in the distal enddirection of the introducing tube 1, whereby the proximal end portion 3a of the clip 3 located at the most distal end is extruded by means ofthe stopper 8. Then, a force is conveyed from the distal end portion ofthe clip 3 to the clip 3 at the distal end side, and the first clip 3located at the most distal end is protruded from the distal end portionof the distal end tip 2.

At the clip 3, the opening/expanding properties are imparted to the armsections 3 b and 3 b′ so as to open the pinch sections 3 c and 3 c′.Thus, the clip 3 is protruded from the distal end tip 2, and at the sametime, the pinch sections 3 c and 3 c′ open. When the manipulating wire 4is retracted while the pinch sections 3 c and 3 c′ are pushed againstthe target tissue 6, the ligating wire 7 can freely move on themanipulating wire 4. Thus, the loop 7 a of the ligating wire 7 on themanipulating wire 4 is hooked by the stopper 8, the clip 3 located atthe most distal end is retracted, and the clip arm sections 3 b and 3 b′bent in the expanding/opening direction are engaged with the distal endportion of the distal end tip 2.

Further, when the manipulating wire 4 is retracted, the projections 3 fand 3 f′ provided at the clip arm sections 3 b and 3 b′ is engaged withthe distal end tip 2, and the traction force is applied onto to the clip3. Then, the proximal end portion 3 a of the clip 3 is plasticallydeformed, and the pinch sections 3 c and 3 c′ close, whereby the targettissue 6 can be pinched. Further, when the manipulating wire 4 isretracted, a portion of connection with the clip 3 of the ligating wire7 breaks, and the manipulating wire 4 and clip 3 are completelyseparated from each other. In this manner, legation of the first clip 3located at the most distal end completes. The second or later clip canbe ligated in the same manner as in the first clip.

According to the second embodiment, the manufacturing cost can bereduced as compared with the first embodiment because no connectionbetween the manipulating wire and ligating wire is made. In addition,the hardening of the manipulating wire due to welding or adhesive of theligating wire is prevented, making it possible to reduce the tractionforce quantity and extrusion force quantity of the manipulating wirewhen an endoscope angle changes.

FIG. 7A to FIG. 7D each show a third embodiment. Like constituentelements in the first embodiment are designated by like referencenumerals. A duplicate description is omitted here.

The manipulating wire 9 movably inserted into the introducing tube 1returns one wire at the distal end of the introducing tube 1, and isformed as two wires at the proximal end of the introducing tube 1. Thismanipulating wire 9 is provided as a twisted metallic wire or a singlemetallic wire, for example, and is made of a polymeric fiber such aspolyparaphenylenebenzo bis oxazol, polyethylene, or a liquid crystalpolymer, and the outer diameter is about 0.3 mm to 1.0 mm. Themanipulating wire 9 may be coated with a polymeric resin with its highslipping properties such as high density/low density polyethylene orpolytetrafluoro ethylene, for example. The thickness of the coat isoptimally about 0.05 mm to 0.1 mm. Further, in order to increase theslipping properties of the manipulating wire 9, it is effective to applyemboss processing of 0.01 mm to 0.45 mm onto the surface of the wire orto apply silicone coil thereto.

The clip 3 is connected to the manipulating wire 9 via the ligating wire10. This ligating wire 10 is formed in a loop shape. This loop is routedthrough the manipulating wire 9 and the proximal end portion 3 a of theclip 3, whereby the manipulating wire 9 and clip 3 are connected witheach other. Further, the ligating wire can freely move on themanipulating wire 9 irrespective of the extruding/retracting movement ofthe manipulating wire 9.

The ligating wire 10 is provided as a twisted metallic wire or a singlemetallic wire, and is made of a polymeric fiber such aspolyparaphenylene benzo bis oxazol or polyethylene. Preferably,polyamide which easily slips on the manipulating wire 9 is desirable.

Further, the outer diameter of the ligating wire 10 is about 0.15 mm to0.6 mm in diameter. In addition, it is required to set the dimensionssuch that the ligating wire 10 breaks when a force of 1 to 5 Kg isapplied during legation of the clip 3. In addition, the loop diameter ofthe ligating wire 10 is 5 mm to 20 mm in diameter. This diameter isdefined as a sufficient length such that the clip 3 does not move inaccordance with the extruding/retracting movement of the manipulatingwire 9.

In addition, when the ligating wire 10 breaks, thereby carrying out cliplegation, if the ligating wire 10 is fully introduced into theintroducing tube 1 at the clip side, when the second or later clip 3 isprotruded, the clip 3 and ligating wire 10 is sandwiched between thedistal end tips 2. As a result, the clip 3 may not be protruded.Therefore, the ligating wire 10 and clip 3 are bonded or fused with eachother. Alternatively, as shown in FIG. 7C, it is desirable that a cutoutbe provided at a portion abutting against the manipulating wire 9, theligating wire 10 be always broken at the manipulating wire 9, and theligating wire 10 be attached to the clip 3 after ligated.

The proximal end of the manipulating wire 9 is inserted into acompression member 11. This compression member 11 has its flexibilitysuch that the compression member can be inserted into the introducingtube 1. In this way, the clip 3 mounted in the introducing tube 1 isprotruded from the distal end portion of the distal end tip 2.

This compression member 11 is provided as a coil sheath havingirregularities on its internal and external faces on which a sectionalround shaped metallic wire (such as a stainless wire) is closely wound.The compression member 11 is moved to the distal end side relevant tothe introducing tube 11 thereby making it possible to extrude the clip 3from the introducing tube 1.

The compression member 11 may be provided a rectangular coil sheathhaving its flat internal and external faces, the coil being closelywound after a sectional round shaped metallic wire (such as a stainlesswire) has been crushed, thereby making the sectional wire facerectangular. Even if the element wire diameter of the same wire is used,a coil sheath with its large inner diameter dimensions can be achievedas compared with the round shaped coil sheath. This makes it easier toprotrude the clip 3 and insert the manipulating wire 9.

The compression member 11 is provided as a tube sheath made of apolymeric resin (such as synthetic polymeric polyamide, high density/lowdensity polyethylene, polyester, polyterafluoro ethylene, tetrafluoroethylene-perfluoroalkylvinyl ether copolymer, tetrafluoroethylene-hexafluoro propylene copolymer). This member has its slippingproperties on the internal and external faces of the sheath, thusfacilitating insertion in the introducing tube 1 and insertion of themanipulating wire 9.

Further, the compression member 11 has its outer diameter such that thecompression member can be inserted into the introducing tube 1 and itsinner diameter such that the manipulating wire 9 can be inserted. Theouter diameter is 3 mm or less in diameter, and the inner diameter ismaximally large.

However, the required thickness is such that the compression member doesnot break even if a force is applied when the clip 3 is extruded. Inaddition, as shown in FIG. 7D, it is desirable that the compressionmember 11 is small in outer diameter at its distal end side, and islarge in outer diameter at its frontal side.

Now, working of a third embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.Then the distal end portion of the introducing tube 1 is located at thetarget tissue 6, for example, the proximity of the gastric mucousmembrane tissue. The compression member 11 is extruded in the distal enddirection of the introducing tube 1, whereby the proximal end portion 3a of the clip 3 located at the most proximal end is compressed by thecompression member 11. Then, a force is conveyed from the distal endportion of the clip 3 to the clip 3 at the distal end side, and thefirst clip 3 located at the most distal end is protruded from the distalend portion of the distal end tip 2.

At the clip 3, the opening/expanding properties are imparted to the armsections 3 b and 3 b′ so as to open the pinch sections 3 c and 3 c′.Thus, the clip 3 is protruded from the distal end tip 2, and at the sametime, the pinch sections 3 c and 3 c′ open. While the pinch sections 3 cand 3 f′ are pushed against the target tissue 6, when two manipulatingwires 9 exposed from the proximal end of the introducing tube 1 areretracted, the legation wire 10 freely moves on the manipulating wire 9.Thus, a loop of the legation wire 10 is hooked on a return portion ofthe manipulating wire 9 at the distal end of the introducing tube 1, theclip 3 at the most distal end is retracted, and the clip arm sections 3b and 3 b′ bent in the expanding/opening direction are engaged with thedistal end portion of the distal end tip 2.

When the manipulating wire 9 is further retracted, the projections 3 fand 3 f′ provided at the clip arm sections 3 b and 3 b′ are engaged withthe distal end tip 2. Then, the traction force is applied onto to theclip 3, the proximal end portion 3 a of the clip 3 is plasticallydeformed, and the pinch sections 3 c and 3 c′ are closed, whereby thetarget tissue 6 can be pinched.

When the manipulating wire 9 is further retracted, the ligating wire 10breaks, and the manipulating wire 9 and clip 3 are completely separatedfrom each other. In this manner, ligation of the first clip 3 located atthe most distal end completes. At this time, a legation wire 10 otherthan that engaged with the clip 3 located at the most distal end has itssufficient length. Thus, this wire does not follow retraction of themanipulating wire 9 and does not move. The second or later clip can beligated in the same manner as in the first clip.

According to the third embodiment, the ligating wire can be easilyconstructed as compared with the first and second embodiments becausethe ligating wire is routed through the manipulating wire and the clipbent portion during construction, thereby making it possible to reducingthe manufacturing cost. In addition, a clip other than that located atthe most distal end does not move when the manipulating wire isretracted during clip legation, thus making it possible to reduce theretraction force quantity of the manipulating wire.

FIG. 8 to FIG. 10 each show a fourth embodiment. Like constituentelements in the third embodiment are designated by like referencenumerals. A duplicate description is omitted here.

In order to prevent a hitch between the clip arm sections 3 a and 3 b′and manipulating wire 9 in the introducing tube 1, a partition member 12is provided between the clip 3 and the manipulating wire 9. Thispartition member 12 is provided as an arc shaped member cutout from aplate material or tube. This partition member 12 may be inserted betweenthe clip 3 and manipulating wire 9, or alternatively, may be securelybonded with the clip 3.

The partition member 12 is provided as a soft member made of silicon,Teflon, polyurethane, polyethylene, polypropylene, polyamide, Gore-Tex,rubber or the like, for example.

Preferably, a biocompatible material is desirable. In addition, thethickness of the partition member 12 is 1 mm or less, the length is 5 mmto 20 mm, and the width is about 3 mm or less.

Now, working of a fourth embodiment will be described here.

The introducing tube 1 of the clip apparatus is introduced into the bodycavity via the channel of the endoscope inserted into the cavity. Then,the distal end portion of the introducing tube 1 is located at theclipping target tissue 6, for example, in close proximity to the gastricmucous membrane tissue. The compression member 11 is extruded in thedistal end direction of the introducing tube 1, whereby the proximal endportion 3 a of the clip 3 located at the most proximal end is extrudedby the compression member 11. Then, a force is conveyed from the distalend of the clip 3 to the clip 3 at the distal end side, and the firstclip 3 located at the most distal end is protruded from the distal endportion of the distal end clip 2.

At the clip 3, the opening/expanding properties are imparted to the armsections 3 b and 3 b′ so as to open the pinch sections 3 c and 3 c′.Thus, the clip 3 is protruded from the distal end tip 2, and at the sametime, the pinch sections 3 c and 3 c′ open.

While the pinch sections 3 c and 3 c′ are pushed against the targettissue 6, when two manipulating wires 9 exposed from the proximal end ofthe introducing tube 1 are retracted, the ligating wire 10 can freelymove on the manipulating wire 9. Thus, a loop of the ligating wire 10 ishooked on a return portion of the manipulating wire 9 at the distal endof the introducing tube 1, and the clip 3 located at the most distal endis retracted. Then, the clip arm sections 3 b and 3 b′ bent in theexpanding/opening direction are engaged with the distal end portion ofthe distal end tip 2.

When the manipulating wire 9 is further retracted, the projections 3 fand 3 f′ provided at the clip arm sections 3 b and 3 b′ are engaged withthe distal end tip 2, and the traction force is applied onto to the clip3. Then, the distal end portion 3 a of the clip 3 is plasticallydeformed, and the pinch sections 3 c and 3 c′ close, whereby the targettissue 6 can be pinched.

When the manipulating wire 9 is further retracted, the ligating wire 10breaks, and the manipulating wire 9 and clip 3 are completely separatedfrom each other. In this manner, legation of the first clip 3 located atthe most distal end completes. At this time, at the clip 3 other thanthat located a the most distal end in the introducing tube 1, thepartition member 12 is inserted between the clip 3 and the manipulatingwire 9, thereby preventing a hitch between the manipulating wire 9 andthe clip arm sections 3 b and 3 b′. The second or later clip 3 can beligated in the same manner as in the first clip.

According to the fourth embodiment, in addition to the advantageouseffect of the third embodiment, an interference between the manipulatingwire and clip arm section does not occur. Thus, there is advantageouseffect that the traction force quantity of the manipulating wire isreduced, thus making it possible to prevent a hitch between themanipulating wire and clip arm section.

FIG. 11 and FIG. 12 each show a fifth embodiment.

Like constituent elements in the third embodiment are designated by likereference numerals. A duplicate description is omitted here.

In order to prevent a hitch between the clip arm sections 3 b and 3 b′and the manipulating wire 9 in the introducing tube 1, there is provideda tube shaped restricting member 13 externally engaged with the armsections 3 b and 3 b′ of the clip 3.

This restricting member 13 is made of a soft material such as silicon orrubber, for example.

Preferably, a biocompatible material is desired. In addition, it isdesirable that perforation 13 a be provided so as to be easily torn sothat the clip 3 expands and opens during legation of the clip 3′.

Further, the thickness of the restricting member 13 is about 0.3 mm orless. Preferably, it is desirable that the restricting member is smallin thickness, and is easily torn.

Now, working of a fifth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is inserted into thebody cavity via the channel of the endoscope inserted into the cavity.Then, the distal end portion of the introducing tube 1 is located at theclipping target tissue 6, for example, in close proximity to the gastricmucous membrane tissue.

The compression member 11 is extruded in the distal end direction of theintroducing tube 1, whereby the proximal end portion 3 a of the clip 3located at the most proximal end is extruded by the compression member11. Then, a force is conveyed from the distal end portion of the clip 3to the clip 3 at the distal end side, and the first clip 3 locate at themost distal end is protruded from the distal end portion of the distalend tip 2.

At the clip 3, the opening/expanding properties are imparted to the armsections 3 b and 3 b′ so as to open the pinch sections 3 c and 3 c′.Thus, the clip 3 is protruded from the distal end tip 2, and at the sametime, the pinch sections 3 a and 3 c′ open. While the pinch sections 3 cand 3 c′ is pushed against the target tissue 6, when two manipulatingwire 9 exposed from the proximal end of the introducing tube 1 areretracted, the ligating wire 10 can move arbitrary on the manipulatingwire 9. Thus, a loop of the ligating wire is hooked on a return portionof the manipulating wire 9 at the distal end of the introducing tube 1.Then, the clip 3 located at the most distal end is retracted, and theclip arm sections 3 b and 3 b′ bent in the expanding/opening directionare engaged with the distal end portion of the distal end tip 2.

When the manipulating wire 9 is further retracted, the protrusions 3 fand 3 f′ provided at the clip arm sections 3 b and 3 b′ are engaged withthe distal end tip 2. Then, the traction force is applied only to theclip 3, the proximal end portion 3 a of the clip 3 is plasticallydeformed, and the pinch sections 3 c and 3 c′ close, whereby the targettissue 6 can be pinched.

When the manipulating wire 9 is further retracted, the ligating wire 10breaks and the manipulating wire 9 and clip 3 are completely separatedfrom each other. At this time, the clip 3 other than that located at themost distal end in the introducing tube 1 prevents a hitch between themanipulating wire 9 and the clip arm sections 3 b and 3 b by means ofthe restricting member 13. In this manner, legation of the first clip 3located at the most distal end completes.

Similarly, with respect to the second or later clip, the compressionmember 11 is extruded in the distal end direction of the introducingtube 1, whereby the clip 3 located at the most distal end is protrudedfrom the distal end portion of the distal end tip 2. The clip 3 isprotruded from the distal end tip 2, and at the same time, therestricting member 13 is torn by the opening/expanding properties of theclip 3, and the pinch sections 3 a and 3 c′ open. The second or laterclip can be ligated in the same manner as in the first clip.

According to the fifth embodiment, in addition to the advantageouseffect of the third embodiment, the expansion of the clip arm sectionsis restricted in the introducing tube by means of the restrictingmember. Thus, a hitch between the internal face of the introducing tubeand the clip arm section is reduced. Thus, there is an advantageouseffect that the extrusion at the compression member 11 can be carriedout with a smaller force when the clip is extruded in the distal enddirection of the introducing tube.

FIG. 13A to FIG. 13C and FIG. 14 and FIG. 15 each show a sixthembodiment. In FIG. 13A, although five clips are configured, clips 14may be mounted in series as long as a space in the introducing tube 1 ispermitted. That is, if a sufficient space in the introducing tube 1 isprovided, six and more clips 14 may be mounted.

At the clip 14 according to the present embodiment, a metallic thin bandplate is bent at its center portion, and the bent portion is defined asa proximal end portion 14 a. Then, both arms 14 a and 14 b′ extendingfrom this proximal end portion 14 a are formed in the shape such thatthey are crossed each other. The proximal end portion 14 a of the clip14 is formed in a substantially oval shape. Further, the distal end rimportions of the arm sections 14 a and 14 b′ of the clip 14 are bent soas to face to each other, and these portions are defined as pinchsections 14 c and 14 c′. One of the distal ends of the pinch sections 14c and 14 c′ is formed in a protrusive shape 14 d so as to easily pinchthe living tissue, and the other is formed in a recess shape 14 e. Then,the opening/expanding properties are imparted to the arm sections 14 band 14 b′ so as to open the pinch sections 14 c and 14 c′. As a materialfor the thin band plate of the clip 14, there are employed a stainlesshaving resilience or an ultra-elastic alloy such as a nickel titaniumalloy.

Further, a clip tightening ring 15 is engagingly fitted to the clip 14.The clip tightening ring 15 is molded of a resin and a metal havingrigidity and elasticity. A pair of two blades 15 a and 15 a′ that areelastically deformed and disposed to be arbitrarily protruded andrecessed in the circumferential direction are provided at the outerperiphery of the ring. The number of blades may be three or four withoutbeing limited to one or two. When an external force is applied to thecircumferential face of the ring in the vertical direction, the blades15 a and 15 a′ are folded on the internal face of the clip tighteningring 15. The blades 15 a and 15 a′ come into contact with the internalface of the distal end tip 2, and inclined faces 15 b and 15 b′ areprovided at their distal end sides. Thus, these blades can be extrudedfrom the introducing tube 1 and distal end tip 2 smoothly and withoutresistance.

The clip tightening ring 15 is engagingly fitted to the clip armsections 14 b and 14 b′, whereby the clip arm sections 14 b and 14 b′are opened, and these arm sections are formed in a substantially tubularshape. The clip 14 and manipulating wire 9 are engaged with each otherby routing the legation wire 10 through the clip proximal end portion 14a.

The blades 15 a and 15 a′ of the clip tightening ring 15 may be mountedin the introducing tube 1 while these blades are folded. When the blades15 a and 15 a′ are mounted in the introducing tube 1 while they areprotruded, elasticity of the blades 15 a and 15 a′ can be maintainedover a long period of time. In addition, a contact resistance betweenthe inner face of the introducing tube 1 and the blades 15 a and 15 a′each is reduced. Thus, the force quantity can be reduced when the clip14 is moved in the introducing tube 1.

The clip tightening ring 15 injection-molds a resin having rigidity andelasticity (polybutytelephthalate, polyamide, polyphenyl amide, liquidcrystal polymer, polyether katone, or polyphthalic amide).Alternatively, an elastic metal (such as stainless or ultra-elasticalloy such as nickel titanium alloy) is molded by injection molding,grinding processing, plastic processing.

A tubular portion of this clip tightening ring 15 is about 0.6 mm to 1.3mm in inner diameter, and is about 1.0 m to 2.1 mm in outer diameter.The outer most diameter portion when the blades 15 a and 15 a′ areprotruded is defined as 1 mm or more in diameter in consideration ofengagement with the distal end tip 2.

Now, working of a sixth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.Then, the distal end portion of the introducing tube 1 is located at theclipping target tissue 6, for example, in close proximity to the gastricmucous membrane tissue. The compression member 11 is extruded in thedistal end direction of the introducing tube 1, whereby the proximal endportion of the clip tightening ring 15 located at the most proximal endis extruded by means of the compression member 11. Then, a force isconveyed from the clip tightening ring 15 to the clip 14 located at themost proximal end. Further, the force is conveyed from the distal endportion of the clip 14 to the clip tightening ring 15 at the distal endside, and the first clip 14 and clip tightening ring 15 located at themost distal end is protruded from the distal end portion of the distalend tip 2.

The blades 15 a and 15 a′ of the clip tightening ring 15 are folded whenthey pass through the inside of the distal end tip 2. When the bladespass through the distal end tip 2, the blades 15 a and 15 a′ areprotruded again. In this manner, the clip tightening ring 15 isprevented from entering the inside of the distal end tip 2 again.

While the pinch portions 14 a and 14 a′ of the clip 14 are pushedagainst the target tissue 6, when two manipulating wires 9 exposed fromthe proximal end of the introducing tube 1 are retracted, the legationwire 10 can freely move on the manipulating wire 9. Thus, a loop of thelegation wire 10 is hooked on a return portion of the manipulating wire9 at the most distal end of the introducing tube 1 and the clip 14located at the most distal end is retracted. Then, the blades 15 a and15 a′ of the clip tightening ring 15 are engaged with the distal endportion of the distal end tip 2.

When the manipulating wire 9 is further retracted, an oval section ofthe proximal end portion 14 a of the clip 14 is introduced into the cliptightening ring 15. Here, the dimensions of the oval section are largerthan the inner diameter of the clip tightening ring 15, and thus, theoval section is crushed by the clip tightening ring 15. Then, the cliparm sections 14 b and 14 b′ open significantly in outward direction.

In this state, the clip 14 is guided so as to pinch the target livingtissue. Further, by retracting the manipulating wire 9, the arm sections14 a and 14 b′ of the clip 14 are introduced into the clip tighteningring 15, and the pinch sections 14 c and 14 c′ of the clip 14 areclosed. While the living tissue 6 is sandwiched between the clip armsections 14 b and 14 b′, the manipulating wire 9 is further retracted.Then, the ligating wire 10 breaks, and engagement between themanipulating wire 9 and clip 14 is released. In this manner, the firstclip 14 located at the most distal end can be retained in the bodycavity while the living tissue 6 is clipped. The second or later clipcan be ligated in the same manner as in the first clip.

According to a sixth embodiment, in addition to the advantageous effectof the third embodiment, the clip arm section is closed by means of theclip tightening ring. Thus, there is an advantageous effect that aliving tissue can be ligated with stronger force.

FIG. 16A to FIG. 16D each show a seventh embodiment. Like constituentelements in the third embodiment are designated by like referencenumerals. A duplicate description is omitted here.

As shown in FIG. 16A, the distal end tip 2 whose inner diameter isgradually narrower toward the distal end portion is securely fixed tothe distal end portion of the introducing tube 1. The manipulating wire22 consists of an expansion portion 22 a and a proximal end wire 22′.The proximal end wire 22′ and manipulating wire 22 are welded or bondedwith each other. Alternatively, when a core wire of the proximal endwire 22′ composed of a twisted metal wire is used for the manipulatingwire 22, only one wire will suffice. Thus, the number of parts isreduced, and the manufacturing cost can be reduced. The diameter of theproximal end wire 22′ is about 0.3 mm to 1.5 mm.

A plurality of clips 3 are mounted in series at the distal end side ofthe introducing tube 1. These clips 3 are basically identical to thoseaccording to the first embodiment. A drilled hole 3 g is provided at abent portion of the proximal end portion 3 a, and the manipulating wire22 is inserted into this dripped hole 3 g. An expansion portion 22 awhich is slightly larger than the dripped hole 3 g is provided at thedistal end portion of the manipulating wire 22. This expansion portion22 a is engaged with the proximal end portion 3 a of the clip 3 at themost proximal end. In a state in which the clip 3 is mounted in theintroducing tube 1, the pinch sections 3 c and 3 c′ of the clip 3 abutagainst each other while the proximal end portion 3 a of the immediatelypreceding clip 3 is pinched.

Now, working of a seventh embodiment will be described here.

When the proximal end wire 22′ is advanced or when the introducing tube1 is retracted from the state shown in FIG. 16A, the clip 3 at the mostdistal end is advanced via the second and third clips 3. When the clip 3is further pushed, the pinch sections 3 c and 3 c′ of the second clip 3clipping the first proximal end portion 3 a abut against the internalwall of the distal end tip 2, as shown in FIG. 16B. Then, the secondclip 3 is inhibited from being protruded from the distal end portion ofthe introducing tube 1. As shown in FIG. 16B, the arm sections 3 b and 3b′ of the clip 3 at the most frontal end significantly open. In thisstate, when the proximal end wire 22′ is retracted, the projections 3 fand 3 f′ provided at the arm sections 3 b and 3 b′ of the clip 3 areengaged with the tip end portion of the distal end tip 2, as shown inFIG. 16C, and the traction force is applied only to the clip 3. When theproximal end wire 22′ is further retracted, the proximal end portion 3 aof the clip 3 is plastically deformed. Then, the pinch sections 3 c and3 c′ are closed, and the target tissue 6 can be pinched.

When the proximal end wire 22′ is further retracted, as shown in FIG.16D, a hole 3 g of the proximal end portion 3 a of the clip 3 isenlarged after deformed by the distal end expansion portion 22 a of themanipulating wire 22, whereby the manipulating wire 22 can retain theclip 3 in a living tissue. The second or later clip 3 is manipulated inthe same manner as in the first clip. In this manner, clips can beprotruded and ligated by only one shot.

Therefore, there is no need to carry out careful protrusionmanipulation, and operation can be simplified. In addition, whencontinuous legation is carried out, the surgical operation time can, bereduced, and burdens on the patient and surgeon can be reduced. Inaddition, the number of parts is reduced, and the manufacturing cost canbe reduced.

FIG. 17A to FIG. 17E, FIG. 18A, FIG. 18B, and FIG. 19 each show aneighth embodiment. Like constituent elements in the sixth embodiment aredesignated by like reference numerals. A duplicate description isomitted here.

As shown in FIG. 17A, three clips 14 shaped in the same manner as in thesixth embodiment and a clip tightening ring 29 as shown in FIG. 19 arealternately disposed in series each other in the introducing tube 51.The clip tightening ring 29 has the same structure as that according tothe sixth embodiment, as shown in FIG. 15. That is, blades 30 a and 30a′ are provided as at least one pair of engaging means that is formed inthe cylindrical shape made of a synthetic resin having elasticity or ametal and that is protruded in the circumferential direction at thedistal end portion.

At the distal ends of the blades 30 a and 30 a′, downwardly inclinedfaces 30 b and 30 b′ are formed toward the distal end of the cliptightening ring 29 in order to come into contact with the internal faceof the distal end tip 2. In addition, a cylindrical short diameterportion 31 a is provided at the distal end 31 of the clip tighteningring 29.

In addition, as shown in FIG. 17A to FIG. 17E, the clip 3 is connectedto the manipulating wire 9 via the ligating wire 10. This ligating wire10 is formed in a loop shape. This loop is routed into the manipulatingwire 9 and the proximal end portion 3 a of the clip 3, whereby themanipulating wire 9 and clip 3 are connected with each other. Further,the ligating wire can freely move on the manipulating wire 9irrespective of the advancing/retracting movement of the manipulatingwire 9.

In addition, as shown in FIG. 18A and FIG. 18B, a rod shapedmanipulating section main body 24 is provided at the manipulatingportion 23. The proximal end portion of the introducing tube 1 is fixedat the distal end portion of the manipulating section main body 24 bymeans of a fixing screw 25. The proximal end portion of the compressionmember 11 inserted into the introducing tube 1 is inserted into theinternal cavity of the manipulating section main body 24, and isconnected with a first slider 26 movably engaged with the manipulatingsection main body 24. Further, the proximal end portion of themanipulating wire 9 inserted into the compression member 11 is extendedto the proximal end side of the manipulating section main body 24, andis connected with a second slider 27 movably engaged with themanipulating section main body 24. In addition, a finger hook ring 28 isprovided at the proximal end portion of the manipulating section mainbody 24.

Therefore, the compression member 11 is advanced by manipulating thefirst slider 26, whereby the clip 3 can be protruded, and ligatingmanipulation of the clip 14 can be carried out via the manipulating wire9 by manipulating the second slider 27.

Now, working of an eighth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.Then, the distal end portion of the introducing tube 1 is located inclose proximity to the clipping target tissue 6. When the compressionmember 11 is extruded in the distal end direction of the introducingtube 1 by manipulating the first slider 26 from the state shown in FIG.17A, the first clip 14 located at the most distal end connected to themanipulating wire 9 and the clip tightening ring 29 are protruded fromthe distal end portion of the distal end tip 2, as shown in FIG. 17B.

The blades 30 a and 30 a′ of the clip tightening ring 29 are folded whenthey pass through the inside of the distal end tip 2. When they passthrough the distal end tip 2, the blades 30 a and 30 a′ are protrudedagain.

As shown in FIG. 17C, when the manipulating wire 9 is retractedbackwardly by manipulating the second slider 27, the proximal endportion 31 of the clip tightening ring 29 is introduced from the distalend tip 2 into the introducing tube 1. However, the blades 30 a and 30a′ abut against the distal end tip 2, and prevent the clip tighteningring 29 from entering the introducing 1 again. When the manipulatingwire 9 is further retracted backwardly, the proximal end portion 14 a ofthe clip 14 is introduced into the clip tightening ring 29 via helegation wire 10, and the pinch portions 14 c and 14 f′ of the clip 14open.

In this state, while the pinch portions 14 a and 14 a′ of the clip 14are pushed against the target tissue 6, when the manipulating wire 9 isfurther retracted, the arm sections 14 b and 14 b′ of the clip 14 areintroduced into the clip tightening ring 29, and the pinch portions 14 cand 14 c′ of the clip 14 are closed. While the target tissue 6 ispinched by the pinch sections 14 c and 14 c′ of the clip 14, when themanipulating wire 9 is further retracted, the legation wire 10 isbroken, as shown in FIG. 17D. Therefore, the clip 14 and manipulatingwire 9 containing the clip tightening ring 29 are separated from eachother.

In this legation work, as shown in FIG. 17B, the pinch sections 14 c and14 c′ of the clip 14 pinch a short diameter portion 31 a at the proximalend portion 31 of the clip tightening ring 20 connected to the secondclip 14, and the second clip 14 can be inhibited from being protrudedfrom the distal end portion of the introducing tube 1. The second orlater clip 14 can be ligated in the same way as when the first clip ismanipulated.

According to the present embodiment, the clip 14 can reliably receive aforce applied by means of the manipulating wire 9 by using engagingmeans. Thus, the living tissue can be ligated with a stronger force. Inaddition, the arm sections 14 b and 14 b′ of the clip 14 can be closedby means of the clip tightening ring 29, and thus, the living tissue canbe ligated with a further stronger force.

In addition, the pinch sections 14 c and 14 c′ of the clip 14 pinch theclip tightening ring 29, whereby the pinch sections 14 c and 14 f′ ofthe clip 14 bump against the distal end tip 2. Then, only the clip 14and clip tightening ring 29 located at the most distal end can bereliably protruded.

Further, the short diameter portion 31 a of the proximal end portion 31of the clip tightening ring 29 is formed in a cylindrical shape. Thus,there is an advantageous effect that an area which the pinch sections 14c and 14 c′ of the clip 14 pinch is increased, which is easily pinched.

The shape of the clip tightening ring 29 is not limited to the presentembodiment, and the proximal end portion 31 may be formed in a conicalshape, as shown in FIG. 20. When the proximal end portion is thusformed, even if the pinch sections 14 c and 14 c′, of the clip 14temporarily slips off from the proximal end portion 31 of the cliptightening ring 29, since the proximal end portion 31 is formed in aconical shape, the pinch sections 14 c and 14 c′ of the clip 14 canpinch the proximal end portion 31 of the clip tightening ring 29naturally by pressing the compression member 11. In addition, duringassembling, there is no need to intentionally pinch the proximal endportion 31 of the clip tightening ring 29 at the pinch sections 14 c and14 f′ of the clip 14. Thus, assembling can be facilitated.

FIG. 21A to FIG. 21D each show a ninth embodiment. As shown in FIG. 21A,three clips 14 and the clip tightening ring 29 shaped in the same manneras in the eighth embodiment are alternately disposed in series at theintroducing tube 1. However, the proximal end portion 31 of the cliptightening ring 29 according to the present embodiment does not have ashort diameter portion 31 a. According to the present embodiment, whenthe length of the manipulating wire 9 inserted into the introducing tube1 is restricted, and the clip 14 and clip tightening ring 29 areprotruded from the distal end portion of the introducing tube 1 by meansof the compression member 11, the manipulating wire 9 is constructed soas to be protruded from the distal end portion of the introducing tube1.

Now, working of a ninth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.Then, the distal end portion of the introducing tube 1 is located inclose proximity to the clipping target tissue 6. When the compressionmember 11 is extruded in the distal end direction of the introducingtube 1 from the state shown in FIG. 21A, the first clip 14 located atthe most distal end connected with the manipulating wire 9 and the cliptightening ring 29 are protruded from the distal end portion of thedistal end tip 2.

The blades 30 a and 30 a′ of the clip tightening ring 29 are folded whenthey pass through the inside of the distal end tip 2. However, when theypass through the distal end tip 2, the blades 30 a and 30 a′ areprotruded again.

As shown in FIG. 21, when the manipulating wire 9 is retractedbackwardly, the proximal end portion 31 of the clip tightening ring 29is introduced from the distal end tip 2 into the introducing tube 1. Theblades 30 a and 30 a′ abut against the distal end tip 2, and prevent theclip tightening ring 29 from entering the introducing tube 1 again. Whenthe manipulating wire 9 is further retracted backwardly, the proximalend portion 14 a of the clip 14 is introduced into the clip tighteningring 29 via the ligating wire 10. Then, the pinch sections 14 c and 14c′ of the clip 14 open.

In this state, while the pinch sections 14 a and 14 a′ of the clip 14are pushed against the target tissue 6, when the manipulating wire 9 isfurther retracted, the arm sections 14 and 14 b of the clip 14 areintroduced into the clip tightening ring 29. Then, the pinch sections 14c and 14 c′ of the clip 14 are closed. While the target tissue 6 ispinched by the pinch sections 14 c and 14 c′, when the manipulating wire9 is further retracted, the ligating wire 10 is broken as shown in FIG.21D. Therefore, the clip 14 including the clip tightening ring 29 andthe manipulating wire 9 are separated from each other.

During this legation work, the length of the manipulating wire 9 isrestricted so that the manipulating wire is not protruded from thedistal end portion of the introducing tube 1. In addition, this lengthis defined such that the manipulating wire can be protruded from thedistal end of the distal end tip 2 from the rear end of the blades 30 aand 30 a′ of the first clip tightening ring 29 to the proximal endportion. Thus, the second clip 14 can be inhibited from being protrudedfrom the tip end portion of the introducing tube 1. The second or laterclip 14 can also be ligated in the same way as when the first clip ismanipulated.

According to the present invention, the length of the manipulating wire9 is merely restricted. Thus, a complicated structure is eliminated, andthe number of parts is reduced. Therefore, the manufacturing cost can bereduced.

FIG. 22A to FIG. 22D each show a tenth embodiment.

As shown in FIG. 22A, three clips 14 and clip tightening ring 29 shapedin the same manner as in the ninth embodiment are alternately disposedin series at the introducing tube 1. The proximal end portion 14 a ofthe clip 14 is connected to the distal end portion of the manipulatingwire 9 via the ligating wire 10.

A plurality of expansion pieces 31 b that can be expanded/contracted inradial direction are provided at the proximal end portion 31 of the cliptightening ring 29. In addition, a cylindrically shaped extension member34 is securely fixed to an immediate portion of the ligating wire 9.When this extension member 34 is pressed-in between the expansion pieces31 b of the clip tightening ring 29, and the expansion pieces 31 b areexpanded, the extension member is mounted on the introducing tube 1.

The extension member 34 is made of a metal or a resin having itsrigidity, and is fixed with the ligating wire 10 by means of fusionwelding, adhesive, or press-fit and the like. The external diameter ofthe extension member 34 is about 0.7 mm to 1.5 mm in diameter, and thelength is 0.5 mm or more.

Now, working of a tenth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thecavity via the channel of the endoscope inserted into the cavity. Then,the distal end portion of the introducing tube 1 is located in closeproximity to the clipping target tissue 6. The compression member 11 ispushed against the distal end direction of the introducing tube 1 fromthe state shown in FIG. 22A. At this time, a cylindrically shapedextension member 34 is securely fixed to an intermediate portion of theligating wire 10. This extension member 34 is pressed-in between theextension pieces 31 b of the clip tightening ring 29, and the extensionpieces 31 b are extended. Thus, the extension pieces 31 b abut againstthe internal face of the distal end tip 2. Then, the first clip 14located at the most distant end connected to the manipulating wire 9 andthe clip tightening ring 29 are protruded from a distal end portion of adistal end tip 2.

The blades 30 a and 30 a′ of the clip tightening ring 29 are folded whenthey pass through the inside of the distal end tip 2. When the blades 30a and 30 a′ pass through the distal end tip 2, the blades are protrudedagain.

As shown in FIG. 22C, when the manipulating wire 9 is retractedbackwardly, the proximal end portion 31 of the clip tightening ring 29is introduced from the distal end tip 2 into the introducing tube 1.However, the blades 30 a and 30 a′ abut against the distal end tip 2,and prevent the clip tightening ring 29 from entering the introducingtube 1 again. When the manipulating wire 9 is further retractedbackwardly, the proximal end portion 14 a of the clip 14 is introducedinto the clip tightening ring 29 via the ligating wire 10. Then, thepinch sections 14 c and 14 c′ of the clip 14 open. In addition, theextension member 34 slips off from the expansion piece 31 b of the cliptightening ring 29, and the expansion piece 31 b is contracted.

In this state, while the pinch sections 14 a and 14 a′ of the clip 14 ispushed against the target tissue 6, when the manipulating wire 9 isfurther retracted, the arm sections 14 b and 14 b′ of the clip 14 areintroduced into the clip tightening ring 29. Then, the pinch sections 14c and 14 c′ of the clip 14 is closed. While the target tissue 6 ispinched by the pinch sections 14 c and 14 c′, when the manipulating wire9 is further retracted, the ligating wire 10 is broken, as shown in FIG.22D. Therefore, the clip 14 including the clip tightening ring 29 andthe manipulating wire 9 are separated from each other. The second orlater clip 14 can be ligated in the same manner as when the first clipis manipulated.

According to the present embodiment, the clip tightening ring 29 abutsagainst the distal end tip 2 of the introducing tube 1 by means of theexpansion member 34. Thus, only the clip 14 located at the most distalend and the clip tightening ring 29 can be protruded.

FIG. 23A to FIG. 23E each show an eleventh embodiment.

As shown in FIG. 23A, three clips 14 shaped in the same manner as in theninth embodiment and the clip tightening ring 29 are alternatelydisposed in series at the introducing tube 1. The proximal end portion14 a is connected to the distal end portion of the manipulating wire 9via the ligating wire 10. At the proximal end portion 31 of the cliptightening ring 29, an expansion member 35 formed in a bellows shape,the outer diameter of which increases when the compression is appliedand the outer diameter of which decreases when the compression force isreleased, is fixedly mounted on the introducing tube 1.

The bellows shaped expansion member 35 is made of a metal or a polymericresin having resilience. The outer diameter increased when thecompression force is applied is always greater than the inner diameterof the distal end of the distal end tip, which is about 1.1 mm to 3.5 mmin diameter. In addition, the expansion member 35 is securely fixed tothe proximal end portion of the clip tightening ring 29 by means offusion welding, adhesive, or press-fit and the like.

Now, working of an eleventh embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.Then, the distal end portion of the introducing tube 1 is located inclose proximity to the target tissue 6. As shown in FIG. 23A, when thecompression member 11 is extruded in the distal end direction of theintroducing tube 1, the third clip 14 compresses the expansion member 35of the clip tightening ring 29 of the second clip 14. Then, the secondclip 14 compresses the expansion member 35 of the clip tightening ring29 of the first clip 14. Thus, the expansion member 35 is compressed,and the external diameter increases.

Therefore, as shown in FIG. 23B, when the compression member 11 isextruded in the tip end direction of the introducing tube 1, theexpansion member 35 is expanded. Thus, the expansion member 35 abutsagainst the internal face of the distal end tip 2. Then, the first clip14 located at the most distal end connected to the manipulating wire 9and the clip tightening ring 29 are protruded from the distal endportion of the distal end tip 2.

The blades 30 a and 30 a′ of the clip tightening ring 29 are folded whenthey pass through the inside of the distal end tip 2. When the blades 30a and 30 a′ pass through the distal end tip 2, the blades are protrudedagain.

As shown in FIG. 23C, when the manipulating wire 9 is retractedbackwardly, the proximal end portion 31 of the clip tightening ring 29is introduced from the distal end tip 2 into the introducing tube 1. Theblades 30 a and 30 a′ abut against the distal end tip 2, and prevent theclip tightening ring 29 from entering the introducing tube 1. When themanipulating wire 9 is further retracted backwardly, the proximal endportion 14 a of the clip 14 is introduced into the clip tightening ring29 via the ligating wire 10. Then, the pinch sections 14 c and 14 c′ ofthe clip 14 open.

In this state, while the pinch sections 14 a and 14 a′ of the clip 14are pushed against the target tissue 6, when the manipulating wire 9 isfurther retracted, the arm sections 14 b and 14 b′ of the clip 14 areintroduced into the clip tightening ring 29. Then, the pinch sections 14c and 14 c′ of the clip 14 are closed. While the target tissue 6 ispinched by the pinch sections 14 c and 14 c′, when the manipulating wire9 is further retracted, the ligating wire 10 is broken, as shown in FIG.23D. Therefore, the expansion member 35 is spaced from the second clip14. Thus, the compression force relevant to the expansion member 35 isreleased, and the expansion member 35 is decreased in outer diameter.Then, the expansion member 35 passes through the distal end tip 2, andthe clip 14 including the clip tightening ring 29 and the manipulatingwire 9 are separated from each other, as shown in FIG. 23E. The secondor later clip 14 can be ligated in the same manner as when the firstclip is manipulated.

According to the present embodiment, the clip tightening ring 29 abutsagainst the distal end tip 2 of the introducing tube 1 by means of theexpansion member 35. Thus, only the clip 14 located at the distal endand the clip tightening ring 29 can be protruded.

FIG. 24A to FIG. 24D each show a twelfth embodiment.

FIG. 24A shows a state in which the last clip 14 and clip tighteningring 29 shaped in the same manner as in the ninth embodiment aredisposed at the introducing tube 1. The proximal end portion 14 a of theclip 14 is connected to the distal end portion of the manipulating wire9 via the ligating wire 10. A stopper 36 consisting of a short tube isengagingly fitted to the distal end portion of the compression member11, and the outer diameter of the distal end portion of the compressionmember 11 is greatly formed.

The stopper 36 is made of a metal or a polymeric resin and the like, andis reliably fixed at the distal end portion of the compression member 11by means of fusion welding, adhesive, or press-fit and the like. Theouter diameter of the stopper 36 is always larger than the innerdiameter of the most distal end of the distal end tip, and is about 1.1mm to 3.5 mm in diameter. In addition, when the length of the stopper 36increases, the stopper becomes hard, thus making it impossible toextrude the clip 14 during angling. Thus, it is desirable that thestopper length is as short as possible.

Now, working of a twelfth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.Then, the distal end portion of the introducing tube 1 is located inclose proximity to the clipping target tissue 6. As shown in FIG. 24A,when the compression member 11 is extruded in the distal end directionof the introducing tube 1, the last clip 14 and clip tightening ring 29are protruded through the distal end tip 2 of the introducing tube 1, asshown in FIG. 24B. At this time, the stopper 36 at the distal endportion of the compression member 11 abuts against the internal face ofthe distal end tip 2, and the distal end portion of the compressionmember 11 is not protruded from the distal end portion of theintroducing tube 1.

The blades 30 a and 30 a′ of the clip tightening ring 29 are folded whenthey pass through the inside of the distal end tip 2. When they passthrough the distal end tip 2, the blades 30 a and 30 a′ are protrudedagain.

As shown in FIG. 24C, when the manipulating wire 9 is retractedbackwardly, the proximal end portion 31 of the clip tightening ring 29is introduced from the distal end tip 2 into the introducing tube 1. Theblades 30 a and 30 a′ abut against the distal end tip 2, and prevent theclip tightening ring 9 from entering the introducing tube 1 again. Whenthe manipulating wire 9 is further retracted backwardly, the proximalend portion 14 a of the clip 14 is introduced into the clip tighteningring 29 via the ligating wire 10. Then, the pinch sections 14 c and 14f′ of the clip 14 open.

In this state, while the pinch sections 14 a and 14 a′ of the clip 14are pushed against the target tissue 6, when the manipulating wire 9 isfurther retracted, the arm sections 14 b and 14 b′ of the clip 14 areintroduced into the clip tightening ring 29. Then, the pinch sections 14c and 14 f′ of the clip 14 are closed. While the target tissue 6 ispinched by the pinch sections 14 c and 14 c′, when the manipulating wire9 is further retracted, the ligating wire 10 is broken, as shown in FIG.24D. Therefore, the clip 14 including the clip tightening ring 29 andthe manipulating wire 9 are separated from each other.

According to the present embodiment, the stopper 36 is provided at thedistal end portion of the compression member 11. Thus, the distal endportion of the compression member 11 is not protruded from the distalend portion of the introducing tube 1, and only the last clip 14 and theclip tightening ring 29 can be protruded.

FIG. 25A to FIG. 25D each show a thirteenth embodiment.

As shown in FIG. 25A, three clips 14 and a clip tightening ring 29shaped in the same manner as in the ninth embodiment are alternatelydisposed in series at the introducing tube 1. A planar bonding member 37abutting against the distal end tip 2 is connected to the distal endportion of the manipulating wire 9. The ligating wire 10 is engaginglyinserted into the manipulating wire 9. During clip legation, thisligating wire 10 is engaged with the bonding member 37, oralternatively, is engaged with the distal end portion of themanipulating wire. The bonding member is made of a resin or a metalhaving rigidity, and is securely fixed at the distal end of themanipulating wire by means of fusion welding or adhesive. In addition,during wire breakage when the clip is ligated, it is desirable that thebonding member be of size that is free of interference during clipprotrusion.

Now, working of a thirteenth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.The distal end portion of the introducing tube 1 is located in closeproximity to the target tissue 6. As shown in FIG. 25A, when thecompression member 11 is extruded in the distal end direction of theintroducing tube 1, the bonding member 37 abuts against the internalface of the distal end tip 2 by the presence of the clip tightening ring29 as shown in FIG. 25B. Then, the first clip 14 located at the mostdistal end connected to the manipulating wire 9 and the clip tighteningring 29 are protruded from the distal end portion of the distal end tip2.

The blades 30 a and 30 a′ of the clip tightening ring 29 are folded whenthey pass through the inside of the distal end tip 2. When the blades 30a and 30 a′ pass though the distal end tip 2, the blades are protrudedagain.

As shown in FIG. 25C, when the manipulating wire 9 is retractedbackwardly, the proximal end portion 31 of the clip tightening ring 29is introduced from the distal end tip 2 into the introducing tube 1. Theblades 30 a and 30 a′ abut against the distal end tip 2, and prevent theintroducing tube 1 from entering the introducing tube 1 again. When themanipulating wire 9 is further retracted backwardly, the proximal endportion 14 a of the clip 14 is introduced into the clip tightening ring29 via the ligating wire 10. Then, the pinch sections 14 c and 14 c′ ofthe clip 14 open.

In this state, while the pinch sections 14 a and 14 a′ of the clip 14are pushed against the target tissue 6, when the manipulating wire 9 isfurther retracted, the arm sections 14 b and 14 b′ of the clip 14 isintroduced into the clip tightening ring 29. Then, the pinch sections 14c and 14 c′ of the clip 14 are closed. While the target tissue 6 ispinched by the pinch sections 14 c and 14 c′, when the manipulating wire9 is further retracted, the ligating wire 10 is broken, as shown in FIG.25D. Therefore, the clip 14 including the clip tightening ring 29 andthe ligating wire 10 are separated from each other. The second or laterclip 14 can be ligated in the same manner as when the first clip ismanipulated.

According to the present embodiment, the bonding member 37 abuts againstthe distal end tip 2. Thus, only the clip 14 located at the most distalend and the clip tightening ring 29 can be protruded.

FIG. 26A to FIG. 26D each show a fourteenth embodiment.

As shown in FIG. 26A, three clips 14 and the clip tightening ring 29shaped in the same manner as in the ninth embodiment are alternatelydisposed in series at the introducing tube 1. At the inside of theintroducing tube 1, a guide wire 38 is provided with tension over itsaxial direction. The distal end portion of the guide wire 38 isconnected to a post 39 protruded in close proximity to the distal endportion of the introducing tube 1.

The ligating wire 10 is connected to the proximal end portion 14 a ofthe clip 14. This ligating wire 10 is movably inserted relevant to theguide wire 38. In addition, the ligating wire 10 is movably insertedrelevant to the manipulating wire 9 returned in the same way. The post39 is made of a metal or a resin, and is reliably fixed to the internalface of the distal end tip or the distal end portion of the introducingtube by means of fusion welding, adhesive, or press-fit and the like.The post 39 is of size that is free of interference during clipprotrusion. It is desirable that the outer diameter be 1 mm or less, andthe length be 1.5 mm or less. In addition, the guide wire 38 is made ofa single metal wire or twisted wire, or alternatively, a polymeric fiberand the like, and the minimally small diameter is desirable. The guidewire 38 and post 39 are fixed to each other by means of fusion weldingor adhesive.

Now, working of a fourteenth embodiment will be described here.

The introducing tube 1 of the clipping apparatus is introduced into thebody cavity via the channel of the endoscope inserted into the cavity.The distal end portion of the introducing tube 1 is located in closeproximity of the target tissue 6. As shown in FIG. 26A, when thecompression member 11 is extruded in the distal end portion of theintroducing tube 1, the first clip 14 located at the most distal endconnected via the ligating wire 10 located at the distal end portion ofthe manipulating wire 9 and the clip tightening ring 29 are protruded,as shown in FIG. 26B. At this time, the loop portion of the ligatingwire 10 is engagingly locked with the post 39 at the distal end portionof the guide wire 38, and the ligating wire 10 is not protruded from thedistal end portion of the introducing tube 1.

The blades 30 a and 30 a′ of the clip tightening ring 29 are folded whenthey pass through the inside of the distal end tip 2. When these blades30 a and 30 a′ pass through the distal end tip 2, the blades areprotruded again.

As shown in FIG. 26C, when the manipulating wire 9 is retractedbackwardly, the proximal end portion 31 of the clip tightening ring 29is introduced from the distal end tip 2 into the introducing tube 1. Theblades 30 a and 30 a′ abut against the distal end tip 2, and preventsthe clip tightening ring 29 from entering the introducing tube 1 again.When the operating wire 9 is further retracted backwardly, the proximalend portion 14 a of the clip 14 is introduced into the clip tighteningring 29 via the ligating wire 10. Then, the pinch sections 14 c and 14c′ of the clip 14 open.

In this state, while the pinch sections 14 a and 14 a′ of the clip 14are pushed against the target tissue 6, when the manipulating wire 9 isfurther manipulated, the arm sections 14 b and 14 b′ are introduced intothe clip tightening ring 29. Then, the pinch sections 14 c and 14 c′ ofthe clip 14 are closed. While the target tissue 6 is pinched by thepinch sections 14 c and 14 c′, when the manipulating wire 9 is furtherretracted, the ligating wire 10 is broken, as shown in FIG. 26D.Therefore, the clip 14 including the clip tightening ring 29 and themanipulating wire 9 are separated from each other. The second or laterclip 14 can be ligated in the same manner as when the first clip ismanipulated.

According to the present embodiment, the ligating wire 10 is engaginglylocked with the post 39 at the distal end portion of the guide wire 38.The ligating wire 10 is not protruded from the distal end portion of theintroducing tube 1, and only the clip 14 located at the most distal endand the clip tightening ring 29 can be protruded. The second or laterclip 14 can be ligated in the same way as when the first clip ismanipulated.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details and representative embodiments shownand described herein. Accordingly, various modifications may be madewithout departing from the spirit or scope of the general inventiveconcept as defined by the appended claims and their equivalents.

1-5. (canceled)
 6. An apparatus for ligating living tissues comprising:an introducing tube capable of being inserted into a living body cavity;a manipulating wire movably inserted into said introducing tube; atleast two or more clips; a connecting member which causes said clip andsaid manipulating wire to be engaged with each other; and a partitionmember provided between said clip and said manipulating wire.
 7. Amechanism according to claim 6, wherein the mechanism has: a cliptightening ring engagingly mounted on an arm section of said clip,thereby closing a pinch section of said clip; and engaging meansprovided at least one of said introducing tube and said clip tighteningring, which causes said introducing tube and said clip tightening ringto be engaged when said clip and said clip tightening ring are protrudedforwardly of said introducing tube, and inhibits said clip tighteningring from being stored in said introducing tube again.
 8. A mechanismaccording to claim 6, wherein, when a tensile stress is applied betweensaid clip and said manipulating wire, said connecting member isconfigured to be deformed or broken more easily than said manipulatingwire.
 9. An apparatus for ligating living tissues comprising: anintroducing tube capable of being inserted into a living body cavity; amanipulating wire movably inserted into said introducing tube; at leasttwo or more clips; a connecting member which causes said clip and saidmanipulating wire to be engaged with each other; and a restrictingmember which externally engages at least one of a pair of arm sectionsof said clip.
 10. A mechanism according to claim 9, wherein themechanism has: a clip tightening ring engagingly mounted on an armsection of said clip, thereby closing a pinch section of said clip; andengaging means provided at least one of said introducing tube and saidclip tightening ring, which causes said introducing tube and said cliptightening ring to be engaged with each other when said clip and saidclip tightening ring are protruded forwardly of said introducing tube,and inhibits said clip tightening ring from being stored in saidintroducing tube again.
 11. A mechanism according to claim 9, wherein,when a tensile stress is applied between said clip and said manipulatingwire, said connecting member is configured to be deformed or broken moreeasily than said manipulating wire.
 12. An apparatus for ligating livingtissues comprising: an introducing tube capable of being inserted into aliving tissue; a manipulating wire movably inserted into saidintroducing tube; two or more clips having a proximal end portion, andhaving an opening/expanding property in which a pinch section is formedat a tip end of an arm section that extends from the proximal endportion; a mechanism which, when two or more clips are disposed inseries in said introducing tube, and said clips are protruded from saidintroducing tube, prevents a clip other than that mounted at the mostdistal end from being protruded from the introducing tube.
 13. Amechanism according to claim 12, wherein the pinch sections of saidrespective clips are configured to clip a proximal end of a clip locatedat the adjacent distal end.
 14. A mechanism according to claim 12,wherein the mechanism has: a clip tightening ring engagingly mounted onan arm section of said clip, thereby closing a pinch section of saidclip; engaging means provided at least one of said introducing tube andsaid clip tightening ring, which causes said introducing tube and saidclip tightening ring to be engaged with each other when said clip andsaid clip tightening ring are protruded forwardly of said introducingtube, and inhibits said clip tightening ring from being stored in saidintroducing tube again; and a manipulating member movably inserted intoan introducing tube disposed backwardly of the clip tightening ringlocated at the most proximal end.
 15. A mechanism according to claim 14,wherein the pinch sections of said respective clips are configured topinch a proximal end portion of a clip tightening ring located at theadjacent distal end.
 16. A mechanism according to claim 15, wherein aproximal end portion of said clip tightening ring is cylindricallyshaped.
 17. A mechanism according to claim 15, wherein a proximal endportion of said clip tightening ring is conically shaped.
 18. Amechanism according to claim 14, wherein the manipulating wire isdisposed backwardly of a distal end position of the introducing tube,and is configured not to be protruded from the distal end of theintroducing tube.
 19. A mechanism according to claim 14, wherein, aproximal end portion of a clip tightening ring abuts against a distalend portion of an introducing tube by means of an expansion memberengaged into a proximal end portion of each of said clip tighteningrings, and the expansion member is removed from the clip tightening ringby means of legation, whereby the expansion member can be separated froma distal end portion of the introducing tube.
 20. A mechanism accordingto claim 14, wherein there is provided an expansion member whose outerdiameter increases when a compression force is applied to a proximal endportion of each of said clip tightening rings.
 21. A mechanism accordingto claim 14, wherein said manipulating member is configured not to beprotruded from a distal end of the introducing tube. 22-23. (canceled)